Critical Illness Insurance: Does anyone have any... - LUPUS UK


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Critical Illness Insurance


Does anyone have any experience of making a claim against Critical illness Insurance for their SLE? I am unable to work due to the chronic fatigue and other symptoms but because I am lucky enough not to have major organ involvement apparently I don't qualify to make a claim. Thanks in anticipation! !

10 Replies

Hi, same here, I had to finish work (aged 44) due to SLE, but was unable to make a claim against my critical illness insurance, the criteria because like yourself I don't have organ involvement (thankfully) meant that you have to be 'permanently disabled' - this did not match any other criteria or definition of disability that I fall into, i.e. I have a blue badge, receive DLA and ESA and was awarded my occupational pension on basis of ill health retirement.

The criteria for the critical illness cover meant that the disability had to be so profound that anyone who met the criteria would have no mobility at all! And also need 24hr care.

I'm not sure if there is any way around this - maybe look in depth into the policy details, view the criteria (without just taking their word for it over the phone ) and if you believe you meet the criteria discuss with your consultant and ask if they'd support the application - that was the process I followed for ill health retirement.

All the best MargaretGail, it's a minefield out there isn't it.

MargaretGail in reply to Slowmo

Thanks Slomo I see the Specialist in 2 weeks and am going to mention it. My Brother in law is a financial adviser so I'm getting him on the case too.

Slowmo in reply to MargaretGail

Great, I wish you luck and hope you get some results, please let us know how you get on.

Hidden in reply to Slowmo

Hi Slowmo, thanks, i found your post most helpful. Im 39. Bad with SLE but no major organ damage so also apparently not bad enuf to claim on critical insurance. I fear this is getting worse quickly and i may have to stop full time work and reduce my hours alot in the coming months or years. I wanted to ask how i can get ESA and blue badge? How much is ESA? And how bad do we have to be to get the disabled parking badge? I read up on it and thought i wouldnt qualify? Xx

sezzie in reply to Hidden

Hi Singlemumloopy,

sorry to but in but just wanted to say that I was awarded a blue badge last summer for 3 year's. I was awarded the high rate of mobility on dla for a year and advised to go to my local council with my paperwork and fill in a simple firm and I received the badge about a week later. If you do not receive dla then your Dr can fill a section of the form out. Give it a go as on a bad day my badge is a good send. Good luck. X

Will do!

Hi there

I'd say the best thing is to speak with a financial adviser, so your relative should be great to offer advice.

Critical Illness cover is very specific and each condition covered has a definition of disability that has to be met before a claim will be made.

Some are more straight forward, so for example most heart attacks involve certain changes in cardiac enzymes (called troponin), ECG changes and so on, and so having a heart attack in most instances will meet the definition and lead to a payout. The same would go for cancer, so long as it has gone beyond a certain stage (not carcinoma-in-situ) for example.

When it comes to conditions like SLE a diagnosis alone is not enough to meet a payout by the insurer. The insurer will normally only cover those individuals it deems have reached a level of disability/illness that is in keeping with their policy, and crucially that they can measure/prove at the claims stage. So for those of us in pain and suffering from fatigue, although this is disabling, it unfortunately won't meet the definition. However there may be other options under your policy worth exploring.

Whatever definition (wording) the insurer chooses is carefully chosen. The more claims they are likely to pay, the more expensive the policy will cost in the first place. What the policy covers (and does not) unfortunately isn't always made clear by those selling/recommending the policy at the start. To those reading this, I can't recommend highly enough

A) get professional advice for life/critical illness insurance

B) always read the small print

I hope this helps explain a little. I'm sorry if it doesn't resolve your claim and I wish you good luck with the insurer. Your final option if you're not satisfied is to contact the Ombudsman.

Thanks Lupylass it is 7 yrs since I last spoke to them so I will re read the small print, seek financial advice and go back to them.

Hi,margaretgail..i claimed under critical Illness lastyear..after 8months like lupylas said a diagnosis for sle on its own was not the end they stated there was no organ failure and refused my claim..( it was horrible reall because they took the claim on knowing my medical condition.o was very dissapointed..but seek advice definitely..take care good lucj

Thanks Jevan05 thats food for thought. I do have reduced filtration rate on my kidneys 53% maybe I can investigate that

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